THEORETICAL ANALYSIS ON THE DEPTH OF NEEDLE-INSERTION

40.World J. Acu-Moxi. Vol. 15 , No.2 ,June ,2005Literature StudyTHEORETICAL ANALYSIS ON THE DEPTH OF NEEDLE-INSERTIONLIN Wen- jiar( 林文建)College of Acu -moxibustion , Beijing University of TCM , Beijing 100029ABSTRACT In the present paper , the author sums up and analyzes descriptions about needle-insertion depth in Chinese classi-cal medical book Huang Di Nei Jing(《黄帝内经》The Yellow Emperor' s Internal Classic ). In many chapters of Nei Jing , theneedle -insertion depth is stressed to be various according to 1 ) the deficiency or excess of syndromes , 2 ) the patients' constitu-tion ,3 )the severity of disease ,4 )the duration of disease ,5 )the location of disease ,6 )the patient s age ,7 )the location of theneedled acupoint ,8 ) the season , 9 ) the patient s temperament , 10 ) the pulse condition, 11 )the stateof Deqi" , and 12 )thelocation of the running course of meridians. In adition , diferent kinds of diseases and different stages of diseases also need differ-ent depths of needle insertion , different manipulating skills and different stimulating quantity. .KEY WORDS Needle-insertion depth The Yellow Emperor' s Internal Classic Theoretical analysisThe depth of needle-insertion is one of the basicThe Yellow Emperor' s Internal Classic ). Followingtechniques of acupuncture , and also an important fac-is the author' s brief analysis on the depth of needle-tor affecting clinical therapeutic effect and safety.insertion.Appropriate depth of needleinsertion not only helpsan acupuncturist obtain necessary needling sensations1 Deficiency and excess syndromesmore rapidly to raise the therapeutic effect , but alsoLing Shu : Zhong Shi (《灵枢终始》Miracu-avoids possible occurrence of acupuncture accident. Itlous Pivot : End and Beginning ) says " When ap-is just as the words recorded in book Su Wen : Ciplying reinforcing and reducing needling manipula-Yao Lun(《素问刺要论》Plain Questions : On thetions , the acupuncturist must understand the state ofKey Points of Needle Insertion ) that" Diseases aredisease. For excess syndrome ,deeper insertion of thedifferent in the severity , the depth of needle-insertionacupuncture needle is taken and the needle hole isshould be different accordingly and not run counter tothe routine standards. If inserted too deeply , the nee-pressed a moment later after withdrawal of the needledle tip may injure the internal organs; on the con-so as to let pathogens out to the full , while for defi-ciency syndrome , shallower needle- insertion is per-trary ,if inserted too shallowly ,it will not reach theaffected region and may result in stagnation of qi andformed so as to prevent the vital essence from injury ,l.od....... If improper puncture adopted , the treat-and the needle hole is pressed immediately followingremoval of the needle in order to prevent the exoge-ment may induce unexpected severe aftereffects'That is to say , if the needle- insertion is improperlynous pathogens from invasion. ”Generally , hyperac-controlled in the depth , the treatment not only cantivity of pathogenic factors often means excess syn-not relieve the state of disease , but also may bring thedrome and the acupoint is punctured deeper for acti-patient with various unfavorable effects. For this rea-vating the intrinsic vital-qi of Zang-fu organs and qison, in clinical practice , the needle insertion depthof the meridian-collateral system to raise the body' sshould vary according to the patient' s constitution ,resis中国煤化工hogenic factors. In theage , state and location of disease ，the season , thetreatHC N M H Gome , shallower needle-acupuncturist' s experience , location of the acupointinsertion is performed for inspiring wei-qi ( defensive( thickness of muscles ), etc. These basic principlesenergy ) in the superficial part of the body toare recorded in detail in classical medical book Huangstrengthen its protective capacity and avoid leaking ofDi Nei JhgQ8据Nei Jing in short )(《黄帝内经》the vital qi , nourishing vessels and relieving the defi-WorldJ. Acu-Moxi. Vol. 15 , No.2 ,June 2005ciency at last. This is identical to those described inbone layers at that time ); whereas , in the treatmentbook Zhen Jiu Da Cheng (《针灸大成》Great Com-of thinner patients , the needle is inserted to the depthpendium on Acu-moribustion ) that" in performingsimilar to that taken in spring and summer ( beingreinforcing needling maneuver , the operator shouldshallower owing to yang-qi being in the superficialinvigorate qi from the tvei fen' and puncture the acu-portionof the body at that time). Ling Shu : Nipoint shallowly and manipulate the acupuncture nee-Shun Fei Shou (《灵枢逆顺肥瘦》Miraculous Piv-dle mildly ; while in performing reducing needlingot : Circulatory Direction of Meridians and Bodymaneuver , the operator should invigorate qi fromConstitution ) also says " The thinner person hasying fen' by puncturing the acupoint deeply and ma-thinner skin with light color , fewer muscles , thinnernipulating the needle with stronger force" . The ex-lips , lower voice in speaking , lighter blood color withcess syndrome means hyperactivity of pathogenic fac-faster flowing velocity ，being easier in qi -dispersiontors , fullness of both vessels and qi , and deeper nee-and qi-exhaustion and consumption of blood ，so ,dle-insertion is taken to drive pathogenic factors out ;when acupuncture treatment given , shallower needle-the deficiency syndrome refers to exhaustion of the vi-insertion is adopted and the duration of needle reten-tal essence and energy in the interior , hypofunction oftion is shorter". Like these , the ancient Chineseboth vessels and qi , and thus , shallower needle-in-medical workers stressed the needle-insertion depthsertion is given for reducing consumption of vital .should vary on the basis of the patient' s constitutionessence. The needle insertion depth is also one of theand body build. Moreover , the needle insertion depthneedling reinforcing and reducing skills. ZHANG Jie-should also be determined with reference to the pa-bin( a well- known physician of Ming Dynasty ) had atient' s physiological state. For instance , Ling Shu :similar description that" Regarding treatment of ex-Gen Jie(《灵枢根结》Miraculous Pivot : Root andcess syndrome ,deeper needle-insertion should be per-Branch )says ," In the treatment of laborer patientsformed and the needle hole is not pressed immediatelywith stronger constitution ，deeper insertion ancafter withdrawal of the needle in order to expellonger retention of the acupuncture needles are recom-pathogenic factors ，which is called as reducingmended; while in the treatment of patients who aremethod; while in the treatment of deficiency syn-living in clover , thinner acupuncture needle is used todrome，shallower needle-insertion is performed fobe inserted into the shallower layer of the acupointnourishing blood vessels. After removing thearea and is withdrawn rapidly". It means that inacupuncture needle , the needle hole is pressed imme-dealing with different patients of different crowd , thediately for preventing pathogenic factors from inva-acupuncture treatment should be variable according tosion , which is called as reinforcing method" .the patient' s constitution. In short , in book NeiJing , in addition to the depth of needle-insertion is2 Patients' constitutiongiven according to the patient' s constitution , the du-Ling Shu : Zhong Shi ( Miraculous Pivot : Endration of needle retention should also be different fromand Beginning ) says" In performing every type ofperson to person so as to raise the therapeutic effect.needling techniques , the operator has to inspect thepatient' s constitution and the state of Y uan ( primor-3 State of diseasedial )qi first". The patients may be stronger orLing Shu: Zhone Shi ( Miraculous Pivot : Endweaker in body constitution and fatter or leaner inand中国煤化Irally ,if the focus isinbody form , thus , the needle- insertion should vary ac-theYHCNMH Gthe discase belongs tocordingly. Ling Shu : Zhong Shi points out", In theycang in property and shallower needle-insertion istreatment of fatter patients , the needle is inserted totaken; on the contrary , if the focus is in the lowerthe depth similar to that taken in autumn and winterpart , the disease is attributed to yin in property and( being deepEt数把to yang-qi being in the muscle anddeeper needle- insertion is performed.Painful dis-42.World J. Acu-Moxi. Vol. 15 , No.2 ,June 2005eases are mostly caused by obstruction of meridiansmeans cold syndrome , because the cold may cause in-due to invasion of cold pathogen ,and if pain occurs ,voluntary contraction ; on the contrary ，slow pulsedigital pressing can not reach its exact place , meaningusually suggests heat syndrome due to the heat meansthat the focus is in the deeper part of the body , thus ,dilation and slowness in property...... Therefore ,the pain syndrome belongs to yin both in thein the treatment of diseases with cold manifestationspathogenic factor and the affected location. Itchingand tense pulse , the needle is inserted deeply and re-diseases ,only locating in the skin , are generally at-tained for a longer period of time in order to wait fortributed to yang and treated by superficial needle in-recovery of yang-qi against cold pathogen; while insertion" . It denotes that the needle insertion depththe treatment of diseases with slow pulse and mani-should vary on the basis of yin or yang property offestations of heat syndrome ，the needle is insertedthe syndrome ; painful diseases mostly belong to yin-shallowly and removed sooner for eliminating heat:old syndrome , when treated , deep needle-insertionpathogen in the superficial layer of the body”. Theseis adopted. For yang type syndromes as exogenousdescriptions possess a guiding significance in acupunc-wind pathogen induced exopathy , ying-vei dishar-ture treatment of emergency in clinic.mony induced cutaneous itch etc. , usually belongingto heat syndrome ，mild manipulation and shallowerDuration of diseaseinsertion of the needle are applied. Ling Shu : Si ShiLing Shu : Zhong Shi( Miraculous Piwot : EndQi(《灵枢四时气》Miraculous Pivot :Qi of Fourand Beginning ) says " In patients with chronic dis-Seasons ) says " Deeper needle-insertion is given tceases , the pathogenic factors invade the deeper por-patients with severe diseases , while shallower inser-tion of the body , when treated with acupuncture , thetion given to those with light diseases". Severe dis-needle should be inserted deeper and retained for aeases mean hyperactivity of pathogens , when treated ,longer period of time" . If the exogenous pathogenicdeep needle-insertion and reducing needling maneuverfactors invade the human body and accumulate forare mainly adopted for eliminating pathogens，where-long，when treated ，deeper needle- insertion andas , for mild type diseases , the depth of needle-inser-longer retention of needlles are necessary ; in patientstion should be shallower and the stimulating strengthwith acute disease , the duration of disease is short ,milder. Ling Shu : Wei Qi Shi Chang(《灵枢卫气the invaded pathogenic factors are often still in the失常》Miraculous Pivot : Abnormality of Defensivesuperficial part of the body , thus , the needle shouldQi ) has a similar description " Diseases may be locat-be inserted relatively shallowly and withdrawn imme-ed in the skin , muscles , blood system , qi system ,diately after" Deqi" to drive out the pathogens. Inbones ,etc. ,or in the superficial portion or the deepthe process of treatment of diseases , the needle inser-part of the body , which are quite different from eachtion depth should be adjusted appropriately in time a-other. When acupuncture treatment is conducted ,thelong with the extension of the duration of disease.basic principles are that for mild diseases , shallowerneedle- insertion is adopted and fewer needles are5 I ocation of diseaseused , and for severer diseases , deeper needle insertionSu Wen :Ci Yao Lun(《素问刺要论》Plainand more needles are applied.Questions :On the Key Points of Acupuncture ) says ,The acupuncture treatment is conducted in a " Diseases varv in. the, severity and the acupunctureflexible way in the light of changes of the state of dis-needMYH中国煤化工re sllowly acordingneases so as to normalize activities of meridian-qi".ly ,c N M H Guld reach the approprirLing Shu :Xie Qi Zang Fu Bing Xing(《灵枢邪气ate depth ,if inserted too deep ,it may injure the in-脏腑病形》Miraculous Pivot : Pathogenic Evils ,ternal organs ; and if inserted too shallowly ,it cannotZang-fu Organs and Manifestations ) also says ,reach the affected area". For pathologic changes atEvery ty师瓦教摄unt- tense pulse conditions generallydifferent part of the body , the needle- insertion depthWorld J. Acu-Mori. Vol. 15 , No.2 ,June ,2005should be also different. Ling Shu :Guan Zhen(《灵workers with reference to the location of different dis-枢官针》Miraculous Pivot : Official Needles )eases in ancient China.points out " For diseases being superficial in the loca-tion , shallower needle-insertion is indicated , other-6 Patient' s agewise , it may excessively injure the related normalFor inserting an acupuncture needle to an appro-muscles to cause skin carbuncles. For diseases in thepriate depth , the patient' s age should be also consid-superficial portion of the body ，deep needle-insertionered together. Ling Shu : Ni Shun Fei Shoushould be taken , if the needle is inserted shallowly ,( Miraculous Pivot : Circulatory Direction of Merid-not only pathogenic factors cannot be expelled but al-ians and Body Constitution ) says " In middle-agedso a larger skin sore may be produced" , indicatingpeople with strong constitution , both qi and bloodthat it is alright if the inserted needle reaches the af-are full and vigorous and the skin is firm in the defen-fected area , too deep or too shallow insertion will .sive function ,thus ,if the body is affected by exoge-generate unfavorable influence on the relief of dis-nous pathogens，when treated ，the acupuncture nee-eases , and the needle- insertion depth depends on thedle should be inserted deeply and retained for a longerlocation of disease. Su Wen : Tiao Jing Lun(《素问period of time. In child patients , the muscles are del-调经论》Plain Questions : On the Regulation oficate, blood is relatively insufficient and qi weaker ,Meridians ) says" If being located in the vessel , the .when treated , filiform needles are used to be inserteddisease is treated by regulating the blood ;if located insuperficially and withdrawn soon"。As we know thatthe blood ,it is treated by regulating its meridian -col-in young and middle-aged people , both qi and bloodlaterals;if located in qi ,it is treated by regulatingare usually rich ,so , excess syndrome is mostly seen ,Wei' ( defensive) qi ; if located in the muscle,it isdeeper insertion and longer duration of needle reten-treated by modulating Fen Rou(分肉the texture andtion are adopted acordingly ; in children ，theinterspaces of muscles);if located in the tendon ,it isphysique ,qi and blood all are insufficient and weak-treated by modulating tendons ( puncturing the focuser , thinner filiform needles are employed and removedwith red-hot needle ); if located in the bone, it isswiftly ; and in senile people , the physique and qi gettreated by inserting the needle deply.. ..”. It meansweaker , thus , when treated with acupuncture , fewerthat applying appropriate depth of needle-insertionneedles are used , inserted superficially and withdrawnand suitable stimulating quantity in the light of therapidly , and the stimulation should be not too strong.location of the focus may help the body eliminateThese basic principles are also described in book Leipathogenic factors to cure diseases at last. In book .Jing Tu Yi(《类经图翼》Iustrated SupplementaryLing Shu : Guan Zhen ( Miraculous Pivot : Offi-to the Classified Canon ) that' Appropriate needle -in-cial Needles ) various needling methods as Yang Cisertion depth and stimulating quantity adopted on the[ centro-square needling ( for treating superficialbasis of the patients' physique are highly recommend-cold)]and Ban Ci [ extremely shallow needling( fortreating pulmonary tuberculosis )]," Hegu" Ci[(' Hegu”or muscle needling ( for treating numbness7 I ocation of needle- insertionand muscular spasm )], Guan Ci [ articular needlingIn the human body , the thickness of muscles is( for treating rheumatoid arthritis )]and Hui Ci[ re-different at the head . neck，body trunk and fourlaxing needling ( for treating muscular aching andlimbTYH中国煤化工dians , Zang fu organsspasm)], Shu Ci[ Shu ( stream )-point needling( forareC N M H Gpoints punctured, thetreating disorders of the five Zang -orangs etc. )] andneedle- insertion depth should vary accordingly. ThisDuan Ci [ short thrust needling ( for treating osteouspoint is just as those described in book Su Wen : Cirheumatism)], etc. are introduced in detail. TheseJin Lun(《素问刺禁论》Plain Questions : On Con-needling瓦有熬据s were created by ancient medicaltraindications in Acupuncture )" The Zang-fu or-World J. Acu-Moxi. Vol. 15 , No.2 ,June 2005gans are very important ，and every acupuncturistor changes of climate in the four seasons" ; Su Wen :should understand this point" . Muscles in the medialZhen Yao Jing Zhong Lun (《素问诊要经终论》part of the four limbs and at the abdomen are thickPlain Questions : On the Essentials of Diagnosis andand acupoints there can be punctured deeply , while atExhaustion of Meridians ) says " Generally speak-the head , the lateral side of the four limbs , chest anding , different needling methods are applicable in theback , muscles are thinner and bones are more , thuscorresponding spring ，summer，autumn and winter 1acupoints there should be punctured superficially. Ifand such is the case in puncturing the related locationinserted too deeply ,it may result in severely harmfulin the four seasons” ; Ling Shu : Zhong Shi ( Mirac-aftereffects. For example " in case of puncturing theulous Pivot : End and Beginning ) says"' The loca-brain tissuse accidentally , the patient may die immedi-tion of yang qi in the human body is changeable alongately"，in case of puncturing the artery in the deepwith the alternation of the climate in the four seasonspart of the head , bleeding and deafness may occur" ;of a year. In spring ,it is mainly situated in the hair ;in case of penetrating the deep tissue under the supr-in summer , situated in the skin ; in autumn , situatedaclavicular fossa or the thoracic wall ( central part ofin muscles，and in winter , situated in the tendons .the chest ) to injure the lung , pneumatothorax mayand bones. Therefore , changes of climate in the fourhappen and cause the patient to have asthma and dys-seasons are considered to be used as one of the stan-pnea immediately" ,etc. which show the importancedards for determining the needle-insertion depth".of proper depth of needle insertion. Su Wen :Ci QiLing Shu : Si Shi Qi ( Miraculous Pivot : Qi ofLun(《素问刺齐论》Plain Questions : On Needle-Four Seasons ) points out " The collaterals of theInsertion Depth ) says " In case of deep insertion ofmeridian are in the superficial part of the body inacupuncture needles( puncturing bones ) , don' t injurewhich is relevant to spring , thus , during spring , inthe tendons ; in case of puncturing tendons , don' tcase of occurrence of ilnesses in the human body dueimpair the muscles ; in case of puncturing muscles ,to invasion of pathogenic factors，the collateraldon' t injure the blood vessels ; in case of puncturingbranches between the subcutaneous fat and musclesvessels ,don' t injure the skin ; in case of puncturingare punctured... ; tiny collaterals of the meridian , lo-the skin ,don' t injure the muscles ; in case of punc-cated at the outer-layer of the body，are correspond-turing muscles , don' t injure tendons ; and in case ofing to summer，when，yang qi is vigorous in thepuncturing tendons , don' t injure the bones" , whichbody surface ,so , in case of onset of diseases ,the tinystresses that when applying acupuncture therapy , thecollaterals of the three yangmeridians in the subcuta-depth of needle-insertion should be mastered strictlyneous tissues are punctured. In autumn , yang qin accordance with the concrete location of the punc-starts to become weaker ，yin-damp gets vigorous ,tured acupoint.thus , in case of onset of illnesses owing to invasion ofpathogenic factors , meridian- acupoints are punctured8 Different seasonsto eliminate yin pathogens. If pathogenic factors in-Functional activities of the human body arevade the fu organ which belongs to yang in the prop-closely related to changes of the four seasons in aerty , the Ho( sea )-point of the sang meridian is tak-year , thus , the needle- insertion depth should be con-en for dispelling sang pathogens. In winter , Jingtrolled correspondingly to the heaven ，earth ，yin( WelL) points. and_ Yine ( spring )points are punc-yang and four seasons. Similar descriptions may alsotured中国煤化工etained for a longer pe-be found in some Chinese classical medical books , forriodYHCNMHGexample, Ling Shu :Ci Jie Zhen Xie(《灵枢刺节Ling Shu : Ben Shu(《灵枢本输》Miraculous真邪》Miraculous Prvot : Acupuncture PrinciplesPivot : Meridian Points ) also says"' In spring , theand Diseases ) says " There are correspondence be-weather is warm , yang qi of the body tends to circu-tween hunah格描g and heaven earth( natural world) late in the superficial part ，thus , when applyingWorld J. Acu-Mori. Vol. 15 , No.2 ,June ,200545.acupuncture，take the collateral branches of theblood and qi may go up reversely , making the patientmeridian in the body surface and Ying ( spring )angry, ... ; in case of puncturing the collaterals ofpoints of the twelve regular meridians as well as thethe meridian in autumn ,qi will get insufficient to besites among muscles or muscular layers. For serverunable to resist exogenous pathogenic factors ,makingcases，deeper needle- insertion is given ，while forthe patient sleepy and indolent to do anything ; in casemilder cases , superficial needle- insertion performed.of puncturing collaterals of the meridian in winterDuring summer , the weather is hot , yang qi of theblood and qi will leak , causing the patient to have se-human body is liable to go out ，and so ，whenvere arthralgia .... All the aforementioned needlingacupuncture therapy is applied ，acupoints of themethods being with reference to the four seasons musttwelve regular meridians , tiny collaterals , skin andbe obeyed in the treatment of disorders of the sixmuscles in the superficial part are punctured. Duringmeridians, if acting against these principles ，theautumn, the air is crisp , yang qi of the body getstreatment will lead to reversed flow of qi to worsenweaker , thus , when punctured ，Ho( sea ) points ofthe state of disease". In order to achieve a betterthe twelve regular meridians are taken , and the othertherapeutic effect ，during different seasons ，theacupoints taken are the same to those used in spring.depth of the needle- insertion should be different ac-In winter , the weather is cold , yang qi hides in thecordingly.interior of the body , thus , when acupuncture is giv-en ,Jing( well) points and Shu ( stream )-points of9 Patient' s temperamentthe twelve regular meridians are punctured deeply toTraditional Chinese medicine holds that the statemanage the internal excess syndrome and the needlesof lucidity and fluidity of qi and blood depends on theretained for a longer period of time to take in enoughhuman' s constitution and temperament , and psycho-warmness for dispelling cold. Nan Jing : Qi Shi Nanlogical activities and the behavioral manifestations are(《难经七十难》Classic on Medical Problems :Thealso different from people to people. Ling Shu : Ni70h Problem ) says " During spring and summer ,Shun Fei Shou ( Miraculous Pivot : Circulatory Di-yang qi is in the upper part of the earth and such is .rection of Meridians and Body Constitution ) says ,the case in the human body , thus , the acupuncture”In acupuncture treatment of younger patients beingneedle is inserted shallowly , whereas during autumnin their prime , particularly those with stronger bonesand winter ,yang qi is in the lower part and thus theand muscles , normal joint movement and steady tem-acupuncture needle is inserted deeply". Biao You Fu .per whose qi flows slowly and blood is thick , the(《标幽赋》Lyrics of Recondite Principles )also pointsacupuncture needle should be inserted deeply ，re-out " During spring and summer , the human body istained for a longer period of time , lifted , thrust andleaner and superficial insertion of the needle is adopt-twirled more times ; and in the treatment of patientsed，while during autumn and winter ，the humanbeing vigorous and with irritable temper whose qubody is relatively fatter , deeper insertion of the needleflows fluently , and blood thinner , the needle is inis performed" . In case of ignorance of changes of the .serted more superficially and retained for a shorter pe-season , improper depth of needle insertion will bringriod of time". Su Wen : Bao Ming Quan Xing Lunthe patient with unnecessary impairment , which has(《素问保命全形论》Plain Questions : On Mainte-detailed explanations in book Su Wen :Si Shi Ci Ninance of Life and Bodv )savs " The depth of needle-Cong Lun(《素问:四时刺逆从论》Plain Questions :inse1MH中国煤化工easonably and iorreAcupuncture in Accordance with the Four Seasons ).insenCN M H Ge patien' s state of dis-It says " In case of puncturing tendons and bones inease . In spite of being the same in their prime ，pa-spring , blood and qi will accumulate in the interior ,tients with steady and introverted disposition belongcausing the patient to have abdominal distension ; ...to yin in the property，their qi flows slowly andin case of pu既uAng tendons and bones in summer ,blood is thick , the needle is inserted relatively deeply46.World J. Acu-Moxi. Vol. 15 , No.2 ,June ,2005and retained longer ; while those with extrovertedformation for clinical differentiation of syndromes andcharacter belong to yangin the nature , and their qitreatment of diseases. For this reason ，we shouldflows freely and blood is thinner , the needle is insert-take the patient' s pulse condition as an important in-ed shallowly and retained for a shorter period of time.dex for acupuncture treatment of any diseases.10 Patient' s pulse condition11 State of' Deqi"LingShu :Jiu Zhen Shi Er Yuan[《灵枢九LingShu : Jing Shui (《灵枢经水》Miracu-针十二原》Miraculous Pivot : Nine Needles andlous Pirvot :Qi and Blood of Meridians )says" BothTwelve Yuan( Primary ) Points ] says" When per-yin and yang meridians of the hand are closer to theforming acupuncture，the acupuncturist has to inspectheart，and their qi comes faster , when acupuncturethe patient' s pulse condition first" . That is to say ,ingiven, the depth of needle- insertion is always lessthe light of the state of disease that is marked bythan2 fen ..”. From this, it can be known thatfunctional activities of the five Zang organs , a rea-when acupuncture is given" Deqi" is generally fastersonable needle-insertion depth is adopted accordingly .from both yin and yang meridians of the hand thanLing Shu : Xie Qi Zang Fu Bing Xing ( Miraculousfrom those of the foot , and the depth of needle inser-Pivot : Pathogenic Evils , Zangfu -organs and Mani-tion for acupoints in the hand part is relatively shal-festations ) points out”In the treatment of patientslower. Ling Shu : Gen Jie ( Miraculous Pivot : Rootwith rapid pulse , the acupuncture needle is insertedand Branch ) says," The general principles fordeeply and retained for a longer period of time ;in theacupuncture are..... ;if the qi flows rather smoothlytreatment of patients with slow pulse , the needle isand needling sensations are achieved rapidly ，smallinserted shallowly and retained for a shorter period ofneedles are employed and retained for shorter periodtime; in the treatment of patients with large pulse ,of time ;if qi flows sluggishly and needling sensationsthe inserted needle is manipulated for reducing energyare achieved slowly , larger needles are applied and in-slightly but avoids bleeding... ; in the treatment ofserted deeply ; and the deeply inserted needles shouldpatients with slippery pulse... ”, which describe dif-be retained longer and the superficially inserted onesferent methods of needle-insertion in the light ofwithdrawn sooner". That is to say，due to variancesslow , acute , large , small , slippery and uneven puls-in patients' individual reactions and velocity of" De-es. In Chapter End and Beginning of Ling Shu ,itqi", the depth of needle- insertion is also different.is recorded that' In the treatment of patients with re-For example , in patients with cold syndrome , the qiplete pulse , reduce its qi ;and in the treatment of pa-flows sluggishly " Deqi" is often more difficulttients with weak pulse , insert the needle superficiallythus , the needle is inserted deeply and retained for ato keep the energy inside for nourishing vessels andlonger period of time so as to wait for arriving of qi.expelling pathogenic factors. In patients with variousGenerally , for patients with fastef" Deqi" , shallowertypes of pain , their pulses are all full , deep needle-in-needle- insertion is taken , those with slowel" Deqi" ,sertion is adopted" . Generally speaking , full ( force-deeper insertion and stronger stimulation are adoptedful ) pulse means hyperactivity of pathogenie factors ，or in supplementation with various qi -promotingunder the circumstances , deep needle- insertion is tak-needling maneuvers for enhancing the therapeutic ef-en for clearing away pathogenic factors. In case of in-fect of acupuncture.中国煤化工sufficiency of vital energy ,the pulse is weak and shal-low needle insertion is given for strengthening the12YHc N M H Gng course of meridi-body resistance to get rid of pathogenic factors. Pulseanscondition may reflect the state of cold or heat , defi-In clinical practice , the depth of needle- insertionciency or excessof qi and blood ,yin and yang ,etc.，is also different according to the meridians selected. .in the interialofthe body and provide important in-Ling Shu : Jing Shui ( Miraculous Pivot : Qi andWorldJ. Acu-Moxi. Vol. 15 , No.2 ,June 200547.Blood of Meridians ) says ," In puncturing Footinsertion category"' Hegu" Ci , Guan Ci , Shu Ci ,Yangming Meridian , the needle is inserted about 6etc. Different needling depths and different stimulatfen ;and in puncturing Foot Taiyang Meridian , theing quantity usually may generate different therapeu-needle is inserted about 5 fen...". Generally , meridi-tic effects. In addition ,different kinds of diseases andans running in the arm，lumbar and abdominal re-different stages of diseases also need different depthsgions can be punctured deeply , because muscles thereof needle insertion ，different manipulating skills andare thicker ; and those running in the head , face，different stimulating quantity. This is just as wordschest , fingers and digitals are punctured suprficially ,recorded in book Ling Shu : Guan Zhen ( Miracu-because muscles there are fewer and thinner. More-lous Pivot : Official Needles ) that" The aforemen-over , the needle-insertion depth may be also deter-tioned three types of needling depth may reach themined according to the nature of yin or syang of theaim of Deqi' by the help of food essence , and themeridians. Ling Shu : Yin Yang Qing Zhuo(《灵枢methods are : performing shallow needling insertion阴阳清浊》Miraculous Pivot : Yin，Yang , Lucidfirst ,i. e. ,penetrating the skin for driving pathogensQi and Turbid Qi ) says "”When yin meridians>ut from the yang portion ; then , holding the needlepunctured，the needles are inserted deeper and re-to advance it to the layer between muscles for elimi-tained for longer time ; while when syang meridiansnating pathogenic factors in the yin portion iat last ,punctured , the needles are inserted shallowly andpushing the needle forward to the interspaces of mus-withdrawn sooner" . Generally , yang meridians be-cles. In this way , reaction of Deqi' may be oblong to superficiality and are punctured superficiallytained". Similarly , Ci Fa ( Acupuncture Methods )and yinmeridians to interiority and puncturedalso says " At the beginning , puncturing the skindeeply .may clear away pathogenic factors from the superficialpart of the body and potentiate the topical circulation13 Conclusionsof blood and qi ; then , insert the needle furtherIn a word , factors determining the depth of nee-deeply so as to eliminate pathogenic factors in the yindle- insertion are various , including different individu-portion. Finally , the needle is advanced to the tex-als , different time , different types of diseases ,differ-ture and interspaces of muscles so as to get Deqi' re-ent meridians，different running sites of meridians ,sponse by the help of food-essence" . Besides , becauseetc. , and should be considered comprehensively.the acupoints distribute in different partsof the body，Various needling methods mentioned in Nei Jing in-some important internal organs may be involved ,clude superficial needle- insertion category ! Mao Ci"thus, the depth and direction of needle- insertion( skin needling )" Fu Ci" ( superficial needling ),should be controlled carefully to avoid injuring the im-Zan Ci" ( repeated shallow needling )" Ban Ci"portant viscera.( extremely shallow needling)" Yang Ci" and' BaoWen Ci" ( leopard-spot needling ), and deep needle-( Accepted on November 11 2004 )中国煤化工MHCNMHG